Dear New Patient,
In order to properly diagnosis and treat you, it is necessary for us to have a complete picture of both your past health history and current symptoms. Our patient intake forms are very thorough and will take a substantial amount of time to complete. Please be as thorough as possible in filling out the form, as this will both save time on your intitial visit and provide us with valuable information on which to begin the diagnostic process.
The patient intake form is available on the links below in both a hand written form which you can fax or mail, and as an e-form which you can fill out on your computer in Acrobat Reader. If you need Acrobat Reader, it's a free download.
REMEMBER: If you download the e-form, you'll need to "Save as" using your name before you start filling it out. After you have completed the e-form you can simply e-mail it back to us as an attachment.
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E-form - New Patient: Full Diagnostic Evaluation |
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E-form - New Patient: Structural Evaluation |
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Fax-form - New Patient: Full Diagnostic Evaluation |
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Fax-form - New Patient: Structural Evaluation |